A New Combined Test with Flowcytometric Basophil Activation and Determination of Sulfidoleukotrienes Is Useful for in vitro Diagnosis of Hypersensitivity to Aspirin and other Nonsteroidal Anti-Inflammatory Drugs

Vol. 136, No. 1, 2005

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Original Paper

A New Combined Test with Flowcytometric Basophil Activation and Determination of Sulfidoleukotrienes Is Useful for in vitro Diagnosis of Hypersensitivity to Aspirin and other Nonsteroidal Anti-Inflammatory Drugs
M.L. Sanz^a, P. Gamboa^b, A.L. de Weck^a

^aDepartment of Allergology and Clinical Immunology, University of Navarra, Pamplona, and
^bAllergy Unit, Hospital Basurto, Bilbao, Spain

Address of Corresponding Author

Int Arch Allergy Immunol 2005;136:58-72 (DOI: 10.1159/000082586)

Key Words

Nonsteroidal anti-inflammatory drugs
Aspirin hypersensitivity
Basophils
Flowcytometry
Sulfidoleukotrienes

Abstract

Background: We assessed whether nonsteroidal anti-inflammatory drugs (NSAIDs) may provoke blood basophil activation in vitro in aspirin- and NSAID-hypersensitive patients, as detected by a flowcytometric technique using the CD63 marker - flowcytometric basophil activation test (FAST) assay - in addition to the sulfidoleukotriene (sLT) release - the cellular allergen stimulation test (CAST). Methods: Sixty aspirin- and/or NSAID-hypersensitive patients were studied. Thirty control patients without history and negative provocation challenge were also included. The percentage of activated basophils after in vitro stimulation with NSAIDs at 3 different concentrations was evaluated by an anti-CD63 phycoerythrin conjugate (FAST assay) and the amount of sLTs released in the cell supernatant by ELISA (CAST assay). Results: For aspirin, the FAST indicated a sensitivity of 41.7%, a specificity of 100%, a positive predictive value of 100% and a negative predictive value of 99.4%; for paracetamol 11.7 and 100%, for metamizol 15 and 100%, for diclofenac 43.3 and 93.3%, and for naproxen 54.8 and 74.1%. Many patients showed positive tests to more than 1 NSAID. When considering the first 4 NSAIDs, the global sensitivity increased to 66.7%, while the specificity remained at 93.3%. The addition of the CAST results still increased the sensitivity up to 73.3%, but with a decrease of the specificity to 71.4%. Conclusions: The FAST shows a high percentage of positive reactions, which may reach 60-70% when 4 NSAIDs are tested and even 88% when the test is performed within 1 month of the last clinical drug exposure and reaction. The test has a high specificity above 90%. The addition of sLT determinations yields additional information in a few isolated cases. It is suggested that this test, when properly used, may help avoid some cumbersome and dangerous provocation challenges.

Author Contacts

Prof. Maria Luisa Sanz
Department of Allergology and Clinical Immunology
Clinica Universitaria, University of Navarra
ES-31080 Pamplona (Spain)
Tel. +34 948 25 54 00, Fax +34 948 29 65 00, E-Mail mlsanzlar@unav.es

Article Information

Received: December 8, 2003
Accepted after revision: July 20, 2004
Published online: December 8, 2004
Number of Print Pages : 15
Number of Figures : 2, Number of Tables : 4, Number of References : 75

Medline Abstract (ID 15608437)

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